MOD S4 - Chronic Inflammation Flashcards
List the effects of chronic inflammation
Fibrosis
Impaired function
Atrophy
Stimulation of autoimmune response
How may chronic inflammation arise?
May take over from or arise alongside acute inflammation
De novo
Autoimmune conditions
Chronic infections
Chronic low level irritation
In severe, repeated or persistent irritation
Give some examples of fibrosis in chronic inflammation
Cirrhosis
Chronic peptic ulcers
Chronic cholecystitis
Give some examples of impaired function in chronic inflammation
Chronic inflammatory bowel disease
Rarely, increased secretion eg mucus secretion, thyrotoxicosis
Give some examples of atrophy in chronic inflammation
Gastric mucosa
Adrenal glands
Give an example of stimulation of immune response in chronic inflammation
Macrophage-Lymphocyte interactions
List the cells principally involved in chronic inflammation
Macrophages Lymphocytes Eosinophils Fibroblasts/myofibroblasts Giant cells
What is the purpose of macrophage cells in chronic inflammation?
Important acutely and chronically
Levels of activation
Functions:
-Phagocytosis and destruction of debris and bacteria
-Processing and presentation of antigen to immune system
-Synthesis of clotting factors, complement components, cytokines and proteases
-Control of other cells by cytokines release
What is the purpose of lymphocyte cells in chronic inflammation?
Sometimes “chronic inflammation cells”
Functions:
-Complex, mainly immunological functions
-B lymphocytes/plasma cells differentiate to form antibodies
-t lymphocytes involved in control (CD4) and some cytotoxic reactions (CD8)
What is the purpose of eosinophils in chronic inflammation?
Allergic reactions
Some tumours
Parasite infections
What is the purpose of fibroblasts and myofibroblasts in chronic inflammation?
Recruited by macrophages
Make collagen
What is the purpose of giant cells in chronic inflammation?
Multinucleate cells Formed by fusion of macrophages by frustrated phagocytosis Types: -Langerhans type (seen in TB) -Foreign body type -Touton type (seen in fat necrosis)
Describe chronic cholecystitis
Caused by repeated obstruction of gall bladder by gall stones
Repeated acute inflammation leads to chronic inflammation and fibrosis of gall bladder wall
Treated by surgical removal
Describe gastric ulceration
Acutely caused by alcohol or drugs
Chronically caused by helicobacter pylori
Occurs due to imbalance between acid production and mucosal defence
H.Pylori treatment is PPI inhibitor eg omeprazole and two antibiotics eg clarithromycin, amoxicillin
Give two examples of inflammatory bowel disease and describe general symptoms
Crohn’s disease
Ulcerative colitis
Inflammatory disease affecting large and small bowel
Patients present with rectal bleeding and diarrhoea
Describe ulcerative colitis
Superficial Diarrhoea Bleeding Treat with immunosuppression Last resort is colonectomy
Describe Crohn’s disease
Transmural
Strictures
Fistulae (abnormal connection between two epithelia)
Treat with immunosuppression and lifestyle changes eg diet/hydration
Describe liver cirrhosis
Chronic inflammation and fibrosis leading to disorganisation of architecture and attempted regeneration Irreversible so requires lifestyle changes and possible transplant Caused by: -Alcohol -Infection with HBV/HVC -Immunological -Fatty liver disease -Drugs and toxins
Describe thyrotoxicosis
Aka Graves’ disease
Autoimmune stimulation of TSH receptors in thyroid follicular cells
Excess T3 and T4 produced
Treated by carbimazole, thyroidectomy, radioactive iodine
Describe rheumatoid arthritis
Autoimmune
Localised chronic inflammation leads to joint damage
Systemic immune response - can affect other organs and cause amyloidosis
Describe granulomas
When immune system walls off something it is unable to eliminate eg bacteria, fungi and other foreign material
Arise with persistent low grade antigenic stimulation and hypersensitivity
What are the main causes of granulomas?
-Mildly irritant foreign material
-Infections:
>Mycobacteria (leprosy and tuberculosis)
>Syphilis
>Some fungi
-Unknown causes:
>Sarcoidosis
>Wegener’s granulomatosis
>Crohn’s disease
Describe tuberculosis
-Caused by mycobacteria
-Produces no toxins or lyric enzymes
-Causes disease by persistence and induction of cell mediated immunity
-Outcomes:
>Arrest, fibrosis, scarring
>Erosion into bronchus
>Tuberculous empyema
>Erosion into bloodstream
